Clinical trials: Duodenal Mucosal Resurfacing (DMR)
UCLH is to be one of the first centres in the world involved in an exciting new trial to treat poorly controlled type 2 diabetes with an endoscopic procedure called duodenal mucosal resurfacing or DMR.
What is the DMR procedure?
New research shows that hormones produced in the intestines have a strong effect on blood sugar levels and that type 2 diabetes may be a disease of the digestive tract. Known as duodenal mucosal resurfacing (DMR), the procedure is a new investigational therapy for type 2 diabetes that targets the area of the small intestine called the duodenum. The duodenum is where absorption of nutrients begins and hormones that control blood sugar levels are produced. The DMR procedure is designed to safely alter the inner surface of the duodenum to change how your body absorbs and processes sugar from your diet. In doing so, it may be possible to improve control of your blood sugar.
How is the procedure performed?
The DMR procedure starts by introducing a flexible camera through the mouth (called an endoscope) to pass through the stomach and into the small intestine. This very common procedure is called an upper endoscopy. With the help of the endoscope, catheters are introduced through the mouth into the small intestine to treat the lining of the first part of the small intestine (called the duodenum) with a heated balloon at the end of the catheter. This thermal treatment modifies the cells that lie along the surface of the duodenum that are responsible for absorbing glucose and releasing hormones into the body that affect glucose control.
What can I expect during/after the procedure?
The DMR procedure is performed under sedation for your comfort, after an overnight fast and takes approximately 90 minutes. You will be closely monitored and may be asked to stay in the hospital overnight before being discharged home. Some dietary modifications will be prescribed for two weeks thereafter.
The REVITA-1 clinical trial is evaluating the safety and potential benefits of the DMR procedure.
You may be eligible to participate if you meet the following criteria. Your doctor can review all inclusion criteria with you to ensure eligibility.
- Elevated HbA1c (7.5% - 11%)
- Presence of type 2 diabetes for < 10 years
- Taking at least one oral glucose lowering medication for at least 3 months
- Not currently taking any injectable glucose-lowering agent
- 28 to 75 years old
- BMI between 24 and 40
After receiving the DMR procedure, you will be asked to visit your doctor periodically for three years to check your progress.
The trial at UCLH is being run by Dr Rehan Haidry, Consultant Gastroenterologist and Director of Endoscopy together with Dr Rachel Batterham, Consultant Endocrinologist, Head of UCLH Obesity & Bariatric Services and Head of the Centre for Obesity Research.